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Peach State Health Plan prior authorization, page 94

CPT code lookup

Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.

Prior authorization codes

Prior authorization codes
CodeDescriptionSource
21123General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21125General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21127General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21137General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21138General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21139General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21141General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21142General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21145General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21146General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21147General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21150General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21151General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21154General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21155General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21159General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21160General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21172General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21175General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21179General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21180General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21181General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21182General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21183General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21184General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21188General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21193General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21194General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21195General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21198General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21199General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21206General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21208General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21209General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21210General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21215General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21230General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21240General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21242General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21243General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21244General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21245General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21246General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21247General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21248General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21249General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21255General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21256General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21260General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy
21261General Orthopedics, Trauma, & Fracture TreatmentCMS Final Rule 0057-F Prior Authorization Requirements, Pg 17 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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